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Please print or W.(Form designed for Use on elite(112•pitch)typewriter.) Form Approvex OMB No.2050.0939 <br /> UNIFORM HAZARDOUS t Generalor i6 Number Z Page t oil 3.Emargency Rasponse Pt" 4, an k mbar <br /> WASTE MANIFEST <br /> Z717 " 416-823-8772 <br /> 5,Generators Nana arvi Maeng Address Ganorat{Ys Site Address lit drmmnl wan rr sng address) <br /> UMVERSAL 7%4,RECYCLING AM,WEMM MW,1017103 <br /> 32M SU)rlcrodo St. <br /> .rro;1!It'r$t,CA 0=5 <br /> GtneralarsPtw'ne: �z. •43,isS,�;:�'�. <br /> 6,TranSpOW 1 Com0fly Name U.S,EPA 10 Number <br /> 4c`�,'S.,,fI <br /> 1.Transporter Company NameU.S.EPA ID Numtset <br /> 8.flex ynate•0 F ty Name and Site Address U.S.EPA ID Number <br /> Hi$wa-y 123 <br /> Faarjsphor."gy"'44'A451 K"amC'wb nn,b t 4452;Q USA <br /> go. 9b.U.S.sD0y Oesagarian C 9 ftW S1rpp4V Nam,Hazard Cass,ID Rtrmker, 10.Conteh M 11.Toth Q.Unit 13 Waste Codas <br /> HM and Pa6wv Group fd any}) No. Typo Ouarmy 4wo, <br /> ... ,® a ).)'. 't . r' (r sq� g"CU <br /> r? tcr•ra-0'a i (,)arta+'), r �a Z <br /> 3. <br /> 4 <br /> i <br /> 14.S;7 31 HandSng Instructions and Adder tnrortnatitrr <br /> IC s°yS'2 C it'? f E'.C C Yt(kr s r J t:T R114LC,AR NfO, Gam' 0 X <br /> Ra f1c;t'?O%M 44N 1 16 ae;% <br /> 15, GEHERATOR'SrOfFEROR'S CERTIFlCATION:I hmt y declare Mat M convents of flys cw4n nant are MY and acamaWy des*8d abo+re by ft MW stag name,arid are , <br /> marled and Ia odJpatarded.errl ora in at wpects in proper ca€dtion for trzn5W acoonan to spolcm itummtlonat and nalkral govemyAntal dalmatians,if wort sup-1 and am the pamatty <br /> Exprutcr<i cor5.y that era cwdants Ues cu sixnant cordorm W U o tem s of fw odadred EPAAci nw sadlnlent of Consonl. <br /> i cer ty that the vrasto nwtcrrdtatiar staianresmt identified€n 40 CFR 262 27(aj(d I em 2laryp luantfiy genemamnr)a{b)(d 1 am a sma!E gtmnb'ty genarabr}b W o. <br /> er exa+«s .amts ypad amu Sinauve s oar <br /> e : �� fc <br /> 16.W--mataaal SNpawntf El m .- <br /> El t f+npxt U.S. ❑Eafaf trcm US. Par ai entry"66t: <br /> Trnrtscattet 'naarca rorax' sant 0ald U.S? <br /> t>: i 7.Tra rs�tterAcirrrN nt of Rece rt of We..,ars <br /> 6iTrampofler i Pnrtecb%p4w Name{ <br /> a iV1L 11 nHLI <br /> � ' <br /> z TranVorter 2 Prmtedrryped Nama cxo ay aur <br /> t8,D=wep y <br /> tea.D;ssopam I,ndeatan space D Quantity D Typ. ❑Residue D Partial Rejed. F.1 Roacd. <br /> MWest Reference Nmanbor. <br /> 18b.h'tomato FnO,?y(or 1334 r, tcx) U,S.EPA 10 NUmbor <br /> a <br /> u <br /> Fans;*s Ptrt.rr: <br /> a18c.S'gnalurc o)Attemato Faddy(or,Gar trotor) N Ath Day Year <br /> S <br /> 19.hazardous Waste Report wnwrrem Method Codon(Le..codas for hatardws wasta hatmenL d4osrl,end retyding systems) <br /> 0 1 2 3 #: <br /> 20.Des4natsd Faoety Ohvt lr of Operator,Cert=tiM of WsiPl of h=tdo-i malars W vM by tlw nwdest axmpt as noted in Item 16a <br /> Pnn'-TyTrdName N o !! '' y� y Year <br /> v V t , 1,tail ) <br /> EPA Farm 670022(Rev.345)P,reV*w editions are obsolete. DESIGNATED FACIUTY TO GENERATOR ST TE(IF REQUIRED) <br />